Few Homeless Shelter Workers Are Trained to Administer Heroin Antidote

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The antidote naloxone. Overdoses were the leading cause of death among homeless people in city shelters last fiscal year.CreditCreditAlex Wroblewski/The New York Times

By Megan Jula

Aug. 24, 2016

An antidote for a heroin overdose is as easy to buy in New York City pharmacies as a bottle of aspirin.

New York State laws have made the antidote, naloxone, available over the counter, and it is sold at nearly 700 pharmacies across the city, where two doses cost around $50.

The laws also protect those who administer the antidote from liability, and the State Health Department provides funding for training and distribution of naloxone kits, which are also used to reverse prescription opioid overdoses. Police officers began carrying the medication in 2012.

But in one environment plagued by overdoses, the city is struggling to ensure enough employees are trained to administer naloxone.

Overdoses were the leading cause of death among homeless people in shelters during the last fiscal year, accounting for 30 percent of fatalities, according to an annual report by the city’s Department of Health and Mental Hygiene.

Yet only a fraction of the 272 city shelters — about 18 percent — have staff members who have been trained by the Department of Homeless Services to administer the antidote. Slightly more than half of the 84 shelters for single adults, where overdoses occur more frequently, have trained the staff.

The department said that teaching employees in all shelters how to administer the antidote is a top priority.

“If we have the ability to save a single life, we have an obligation to try to save a single life, and that is what we have been doing,” said Steven Banks, the commissioner of the city’s Human Rights Administration and Department of Social Services, who oversees homeless services. “By expanding these services further with new training that will be put in place, even more lives will be saved.”

When shelters without trained workers discover a resident who may have overdosed, the staff waits for the police or emergency medical personnel to administer naloxone.

“Waiting for 911 to respond with a kit could be the minutes that you lose somebody,” said James Hollywood, the vice president for residential treatment at Samaritan Village, a human services agency.

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John Wilson, a senior shift supervisor at Forbell Men’s Shelter in Brooklyn, used the antidote five times in five months last year, according to incident reports by homeless services.CreditAlex Wroblewski/The New York Times

Mr. Hollywood oversees the antidote training program at the nonprofit, which has been training employees at its shelters through a partnership with the state’s Heath Department since 2012.

An opioid overdose causes a decrease in a person’s breathing rate that can lead to death, which usually occurs one to three hours after using the drug, rather than suddenly, according to the Health Department.

Training on how to administer the antidote can take five minutes to an hour depending on the circumstances, a department report said. The four basic steps involved are recognition of a potential overdose, contacting emergency medical services, mouth-to-mouth resuscitation and the administration of naloxone.

One of the most important lessons is not to worry about using the antidote, said Dr. Roslynn Glicksman, the medical director for primary care at Project Renewal, a nonprofit with a range of services for homeless people, including five shelters.

“Even if it’s not certain the person has overdosed, you can’t hurt them with Narcan,” she said referring to a brand name of the medication.

Mr. Banks said reforms identified during a 90-day review this year will make expanding training possible. A medical director expected to be named next month will oversee training, he said.

“We are going into the next phase to ensure that we have trained staff at every location, and the medical director will play a role in that,” Mr. Banks said.

The Homeless Services Department began training some employees in 2009.

In 2012, the first year data was collected, the department documented nine successful overdose reversals with naloxonee. Last year, 75 reversal attempts were made, 61 were by peace officers and 14 by staff members, both trained through the department. Sixty-seven were successful.

John Wilson, a senior shift supervisor at Forbell Men’s Shelter in Brooklyn, one of the shelters run by Samaritan Village, used naloxone five times in five months last year, according to incident reports by homeless services.

In June of last year, he found a man sprawled on the bathroom floor and a needle next to him, according to incident reports. The man was unconscious.

Mr. Wilson asked another employee to call 911, then bent down next to the man and administered the antidote. The man started to awaken and was given another dose. The Fire Department arrived and took the man to Brookdale University Hospital and Medical Center in Brooklyn.

In the moment, Mr. Wilson said, he does not have time to overanalyze the situation. He just reacts.

An article on Aug. 25 about how few workers at homeless shelters are trained to administer a heroin antidote referred incorrectly to the medication. It is naloxone, not Narcan. (Narcan is a brand name for naloxone.) The error was repeated in an accompanying picture caption. An earlier version of this correction misspelled the name of the antidote.